Elderly mother wanting hospital discharge against advice

[TheoriginalLEM]

My mother is difficult to say the least. She is 85 and has complex medical needs. She is self neglecting and just over a week ago was admitted to hospital at deaths door, she has carers but was refusing food and water.

She agreed to stay in hospital with a view to a transfer to a cottage hospital for convalesence and rehab. She has MH issues and is under the useless psychiatrist.

The self neglect has been going for a long time.

I don't want her to go home, yes she is better than she was but is frail. She was vile to me yesterday (she always is)- apparently the Dr said she could go home but the nurse said this wasn't true.

I'm going today to hopefully speak to the dr or nurse in charge.

She wants to self discharge but i kniw this will just start the cycle of self neglect and quite frankly, running me ragged, and I think it would be a huge mistake.

The issue is I don't have power of attorney (big mistake) and she has capacity - surely though the medics can step in if someone isn't self caring and refusing care?

I have known consultants to inform family they are having a Best Interest Meeting and to not involve a social worker and actually document that the patient had capacity so just be sure it really is a BIM and that words are not being bandied around that are incorrect. A BIM must be chaired by a social worker and can only be held once it is decided someone lacks capacity to make a certain decision, in this case about what her care needs are.
This is an incredibly hard situation which I see on an almost daily basis but one of the hardest things is getting families to be honest with the person concerned about what they can and cannot do to support. Find if there is a local carer support type group. They will support you and sometimes attend discharge planning and best interest meetings to offer support

@TheoriginalLEM I'm really sorry but you're being totally unrealistic. Sounds like she would send all those people away. She needs a care home, from what you have said. I know this is tough emotionally but if she owns her own home she can sell it and will have the cash to pay for a decent home.

She's miserable out of one. She's at constant risk of the consequences of self neglect out of one. She might as well be in one, be miserable in one and be safe.

Second this. My dad was the same but at least once he was in a care home I didn't have the same terror when I rang and got no answer that he had fallen over and couldn't get up, or had any other accident (including awful toilet related ones) or hadn't eaten anything other than biscuits all day, or had left the front door open all night. I could go on. Being miserable in a safe warm environment where he was fed, cleaned up and cared for was much better. And it's taken time but some months down the line, he's less miserable. I had LPA which made it easier. Was definitely the right decision.

OP I would urge you to ignore people who a) haven't been through this themselves and b) aren't prepared to step up and do the 24/7 caring themselves. Including your daughter. What has she offered as an alternative? You can't judge all care homes by that one. Talk to people who live locally who have relatives in care homes and get recommendations.

Some people can be SO selfish in thinking they will be ok at home with carers and everyone in the family looking after them. No.... I will never go to a nursing home and all that.

Nope. It might work for some, but I put the onus on the person who expects it. End of story. We are far too lenient WRT difficult parents /relatives who need constant minding at home.

Personally I have made it known that they can put me wherever they like. As long as I can get outside every day, that is a deal breaker! Otherwise I don't care. If it gets to that stage I probably won't care anyway!

But just in case!

@waterbottle12 I agree with you, OP you are clinging onto some hope of a normal relationship with her, it’s never going to happen, she’s 85 with lifelong MH issues, she’s not changing into a kind sweet old lady. You need to step back, way back, make it clear you will NOT be caring for her, sadly if her choice is to self neglect then you have to come to terms with it. She’ll never be the mum you want, it’s hard I’ve been there but you have to protect yourself and yours.

Does your DD know how bad your DM is?

Are you shielding your DD from your DM's behaviour?

Your DM needs specialist care that you can't provide.

Your DD needs to understand that.

As someone who works for the ambulance service it's great reading some of the advice and perspectives here. It's a situation we see one side of often in that we have regular elderly callers which are self neglecting alone at home, no matter how much hark on about how much happier/safer/simpler life would be in a care home they just would never accept it and prefer the cycle of live at home/a&e/brief admission/home. If they have capacity and demand to go home ultimately they will be taken home regardless of the situation they will be put into.

Regards expectations for care my experience of the maximum in a patient's own home is: care visits 4x a day to assist with getting up/personal care/meals/meds. Is this what she had before? If not then what this package can include is tailored to patient. Regards meals they will assist someone to eat who is unable through strength/coordination but they will not force feed or really even have much time to coerce verbally. If the patient refuses care/ tells them to leave that's probably what they will unfortunately. I don't believe there would be any point in a dietician, what might work is thinking of something that she will I'm eat, regardless of how healthy it is. Is there something from her past she might enjoy? Even if it's the same meal every day if she'll eat it it's a win!

One tract I've found that can sometimes work when "selling" the idea of a care home is to see if they'd consider trying it for just a week...

Regards the posters saying "just tell them you're not doing anything" this is completely pointless advice and will have no positive bearing. The only outcome I would expect is that staff consider you to be uncaring/regard your opinion as irrelevant.

You haven’t betrayed her. Sounds like she’s bloody lucky she has any contact with you considering how appallingly she’s treats you.

Ooo, another thing that is increasingly common I find is webcams being set up in elderly patients houses. Family members log in when they want and can see if there relative has fallen, or check the carers aren't stealing presumably. I do find this a bit odd but might work for you?

Best of luck, it's an unenviable position to be in but you're not alone. It's replayed all over the country over and over again unfortunately.

Regards tbe capacity assessment ultimately she'll need to demonstrate that she can retain and weigh information to form a decision, then communicate this decision with understanding of the risks she was advised of. If she can do that she has the capacity to make that decision, if not then she doesn't.

I.e. if she just keeps repeating "dont care take me home, I want to go home" without showing further insight then this would evidence a lack of capacity and a best interests decision can be made. However capacity fluctuates so sell the house quickly and it's a moot point then.

She lives in a council house which I suppose makes things easier.

I doubt she has many years left. She's sitting on a timb-bomb of an anyerism and if you had asked me two weeks ago I'd have said she's better off if it blows. Fuck sake she was begging me to end it the other Sunday. Yet a week in hospital and I can see a glimmer of hope of a decent life - why the he'll cant she see this

OP sorry sounds very stressful, as have your previous posts. Just wondering what you think the useless psychiatrist could have done better, that you mentioned in your first post? I also agree with waterbottle12’s point.

hamster those of us that have said about making it clear that the OP will not take responsibility are saying it because we’ve been on several of the OPs other threads about the same issues where the OP is clearly struggling with her own MH and the mother is telling carers / SS that the OP will get shopping etc when she is then refusing to allow the OP to do so . This is not a new issue it’s been going on for a while and at the end of the day the OP has her own family that need her in a fit state and she’s clearly banging her head against a wall hoping that her mum will transform into a nice old lady .

What a horrible situation for you OP. I saw this with my DM and her own DM, although mercifully, my DGM was completely compos mentis and not unpleasant. She was however very frail and needed a great deal of physical help in the last five years of her life. She also refused all external support stating that ‘no, her daughter would do it’. Her daughter, my DM was by this time in her 70s herself and had breast cancer.

I used to get incredibly frustrated with my DM as she would never say no. In the end, I stepped in as fortuitously, my DGM really needed hospital admission and my poor DM was on her knees with exhaustion and worry. I spoke to the GP, was completely honest with him, he got DGM admitted to hospital, where she died a month later. We didn’t wish her dead, in fact we loved her dearly but she was 95. Although my DM was of course sad, she was also incredibly relieved.

I’m of the opinion that other family members have no right to resist somebody going into a care home unless they are fully prepared to take over the care themselves. Would your daughter be prepared to fully take over from you in caring for her GM? No, of course she wouldn’t. In which case she is in no position to object to this course of action.

It isn’t just a case of you not wanting to care for your mother anymore. The reality is she requires far more care than you are realistically able to give. Please be resolute and make this clear to the hospital. You have done as much as is humanly possible. 💐

I'm an ex care worker and worked a lot with people who had mental health issues both in the community and residential care homes.

Im going to go against the grain here and say it could be argued she doesn't have capacity. If, due to her condition she can't use information provided, to make an informed decision. Maybe she needs a mental health advocate, social worker, psychiatric nurse or OT to help her understand the options and consequences but she certainly needs support and if that doesn't work then you've got a strong case.

On a practical level you have no say in that assessment. You can provide information but that one is out of your hands. For now I'd be contacting your local carers service for support. They could provide a support group, an advocate for you or a carers assessment. I have had a lot of support from mine when I've needed support with my autistic daughter and sometimes just talking has really helped me loosing it. Ours has a helpline which is a lifeline for me.

On the care home front I wouldn't be totally dismissive either. Ive had residents arrive kicking and screaming, determined that they are going home, actually settle and get a new lease of life. I've had many with long term mental health issues who once they've had life stresses taken away and more stable routines, including activities, wound up being the happiest they've been in years.

Does the psychiatrist have a good relationship with her? If not then maybe you could ask for a second opinion. With my grandad we found there was a total personality clash with the first one he had but the second was really good and was able to dig a little deeper. Didn't help that the first was a tiny, quiet lady and grandad couldn't take her seriously. The second was a fellow Welshman who loved rugby and cricket so could disarm grandad easily.

Sending loads of love your way. It's a horrible situation to be in. Something has to give somewhere though.

@TheoriginalLEM I’m so sorry but if you are expecting your mother to suddenly give a shit about your quality of life then you’re going to be disappointed. You need to acknowledge that you have done everything you can but you can’t do everything. Looking after a parent in this situation can be almost like an abusive relationship and you need to understand that now for your mother your life and needs aren’t anywhere near as important to her as her own situation but you are not responsible for that. You need to step back for your own health now and your family.

Social Services should assess for capacity (and it’s capacity for this specific decision not capacity for everything) and if it’s found that she doesn’t have the capacity to understand the consequences of her choice then residential care may be the right option. If she doesn’t have savings or property she will be funded and whilst it may not be luxury accommodation we have found it’s the care staff that matter not the decor.

As a child who went through their mother trying to support a similar 'granny' this may not be easy for your family either, after that experience I think you need to step back and out your own DC first. You can keep hoping but sometimes need to accept your mother is not going to change and give you love, no matter what you do.

Also I would check out the elderly parents section in Out of the FOG site, might be helpful for you.

a week in hospital and I can see a glimmer of hope of a decent life - why the he'll cant she see this

After a week in what is effectively a residential care setup? Yes, they were giving her medical treatment (presumably fluids and then reintroducing food?), but after the initial treatment, they are acting as carers.

She can't see what you want her to see. She doesn't care about what you want.

She's not going to turn into a lovely little old lady to have tea and scones with. Never.

But she might turn into a little old lady who is safely looked after in a home, even if she is horrible to staff (and you when you visit).

Really it's full circle like looking after a toddler you give them what they NEED which is not necessarily what they WANT

Elderly people with mental health difficulties (and I include those with dementia like my dad in this - the brain literally cannot work in the way it should) do not and will not ever see the world as you do. They are unable to. It's hard to accept that but once you have, it helps.

She was in a better mood today - by this I mean not effing and blinding at everyone. When i got there she had gone off with the OT to make a cup of tea . Which she managed and they were just asking her some memory related questions. She seemed amenable to this. She also ate a full dinner!

Was this a capacity assesment or home assesment I wonder?

If she would only continue in this vein but at home the anxiety and depression takes over and it's back to square one. I wish I knew what to do to avoid this.

Are they ensuring she is taking medication regularly, unlike at home perhaps. That could make a huge difference to her mood and level of cooperation. Not that this would be sustainable were she to be discharged with no additional support. Is dd1 the dd with her own mental health issues? Her putting pressure on you is not helpful or fair and I doubt she could pick up the slack.

A previous poster mentioned that it is like an abusive relationship. If this level
if coercive control happened between two partners we would call domestic abuse. OP stick to your guns. This is awful.

Well it seems hat she is capable of doing these things and at home chooses not to, causing problems. Making it more difficult for you.